APPEL: How Does Friday’s Obamacare Ruling Affect Louisiana?

The Federal court ruling which found Obamacare invalid creates monumental problems for Louisiana. When Governor Edwards unilaterally accepted Medicaid Expansion he inexorably tied Louisiana’s future to a program that is now on life support. That ruling will absolutely invoke appeal and those appeals, probably up to the Supreme Court, could take years to resolve. If, in the end, it is sustained then and only then will Congress be motivated to create a new system that itself may be challenged.

So where does that leave Louisiana? Well we and many other states will be left hanging in limbo as costs accelerate and people become more accustomed to dealing with a system of nationalized healthcare that has an indeterminate but finite life; a Federal system that will disappear with no early prospect of replacement. In the meantime we will have contracts in place and internal structures of finance for our managed care organizations, partner hospitals, and other entities that also have finite lifetimes. In order to protect themselves these institutions will be scrambling to secure evermore guaranteed commitments from the state, even as the state has no idea where its underlying funding will come from.

In simple terms Louisiana’s linkage to Obamacare may be recorded in history as the worst and most costly mistake ever made by a governor. Ironically had the governor not decided to use his executive authority and had he worked with the legislature perhaps through compromise we would not be is such a delicate situation. But he, much like President Obama, wanted a legacy issue, so he did not even try to work with anyone. By doing so he now owns a potential disaster.

Of course in long run the demise of Obamacare may well be the best thing for our nation and our state. We all remember the promises made by President Obama and Democrats in Congress:

Obamacare will end the uninsured in America – actually there are currently nearly 30 million uninsured and that number is growing, mainly because of the outrageous costs of Obamacare. The middle class is being punished as it is the majority of the population and as a result it is from them that most of the costs of socialized medicine are being derived.

Obamacare will save every family on average $2,400 per year – actually both the cost and the deductibles have gone up astronomically making all but government run healthcare out of reach for the working class.

Obamacare will allow you to keep your doctor if you choose – actually that is not the case, in most cases you must use a doctor who is selected by others. This will only get worse as so many doctors refuse to take Medicaid payments. Obamacare’s bureaucracy and low reimbursements are forcing doctors to retire early and young people not to choose medicine as a career creating a serious shortage of doctors.

Obamacare will help the middle class – actually it is the middle class that has been hurt the most by Obamacare. Workers who once had great health insurance provided by their employers have been forced onto government insurance that they don’t want. The middle class is targeted by the taxes needed to sustain Obamacare. Those in the middle class who are forced to find their own insurance get no subsidy and are slammed with high cost, limited coverage, and astronomical deductibles.

Obamacare will stabilize total healthcare spending – actually healthcare spending growth in 2008, the year before Obamacare took effect, had dropped to a historic low. In 2008 the average spent per capita was $7,845 but by 2018 it had grown almost 50% to $11,193 per capita. Obamacare seems to have stimulated costs, not controlled them.

And we all remember Speaker Nancy Pelosi’s infamous admission – “We have to pass it to know what is in it”.

It would appear that Obamacare was never intended to resolve the issues that prevailed before it was rammed through Congress by the Democrats. In fact, the thought is that it was truly just designed to demolish the American healthcare system to make way for socialized medicine. Judging by the socialist messages of today’s Democrat Party it would seem that indeed it was just a sinister strategy toward collectivism that was always what the Democrats intended.

So eight years later Obamacare is a system that has only exacerbated our long-term problems. After spending trillions of dollars more than ever before and after destroying the traditional health insurance market Obamacare has failed to address the real issues, healthcare outcomes and security for the middle class. Ironically, as noted, it is actually the middle class that is suffering the most under Obamacare as taxes hit them hardest and costs and deductibles explode even as availability of healthcare declines. Socialized medicine is anti-American and does not work. The insiders get fat and the citizens pay for it, while healthcare outcomes don’t improve that much.

But now the court has ruled that the Democrats overreached the fundamental law that governs our free country. Our Constitution after all was designed to limit the scope of government intrusion into the lives of Americans, something nationalized healthcare clearly does. If the ruling that Obamacare is unconstitutional stands, then the irony is that a document drafted to defend liberty from monarchical domination over 200 years ago will still prove its imperative in the 21st century.

Back in Louisiana the governor responded to the ruling with emotional but totally illogical statements. He Tweeted out bitter responses to the ruling, first by attacking the Attorney General and then by stating that his sole goal will be to force the legislature to provide coverage for 850,000 who have pre-existing conditions and 450,000 who are in the current Medicaid Expansion population. Without a Federal program such a ludicrous proposal would cost Louisiana tens of billions of dollars. Either our governor doesn’t understand healthcare financing, or, in a more sinister way, he does and is just making an absurd statement to play to his base and to cover his failed policy. Either way his Tweets seem to have lost touch with reality.

Yes, as a state we need a healthcare strategy that is constitutional, that creates a healthcare safety net without impoverishing the middle class, and that protects those with pre-existing conditions. But such a strategy must not be at the expense of eliminating all available resources to fund state priorities. In order to be realistic that strategy must be in alignment with a Federal plan because, despite the governor’s bombastic statement, we cannot fund anything like that in Louisiana without substantial Federal underwriting.

As we enter into what may be a protracted struggle over nationalized healthcare we must be mindful of lurking dangers to our state’s future. Until the issues resolve themselves there should be serious concern about any proposals to “fix” Medicaid Expansion or any other aspect of our state’s healthcare strategy. We are in a precarious position brought on by a unilateral commitment to link our state to an invalid Federal law. Now we need answers and clear vision, not emotional reactions, to unwind the mess we are in and then to recreate a healthcare structure that actually fulfills its purpose.